The Uninsured: A Primer - Key Facts about Health Insurance and the Uninsured in the Wake of National Health Reform

The ACA led to historic drops in the uninsured rate, with millions of previously uninsured Americans now insured and gaining access to health services and protection from catastrophic health costs. Prior to the ACA, the options for the uninsured population were limited in the individual market, as coverage was often expensive and insurers could deny coverage based on health status. Medicaid and CHIP have provided coverage to many families, but pre-2014 eligibility levels were low for parents and few states provided coverage to adults without dependent children. The ACA fills in many of these gaps by expanding Medicaid to low-income adults and providing subsidized coverage to people with incomes from 100 to 400% of poverty in the marketplaces.

Nonetheless, even with the ACA, the nation’s system of health insurance continues to have many gaps that currently leave millions of people without coverage. Over half (57%) of the remaining uninsured are outside the reach of the ACA either because their state did not expand Medicaid, they are subject to immigrant eligibility restrictions, or their income makes them ineligible for financial assistance. The remainder are eligible for assistance under the law but may still struggle with affordability and knowledge of options and require targeted outreach to help them gain coverage. For both eligible and ineligible remaining uninsured people, health care needs persist regardless of insurance status, underscoring the importance of safety net providers and community health clinics to serve this population.1

The ACA has provided coverage to millions of people in the United States in its first three years and has the potential to reach many more, ensuring that fewer individuals and families will face the health and financial consequences of not having health insurance.

Rachel Garfield and Julia Foutz are with the Kaiser Family Foundation. Melissa Majerol was previously with the Kaiser Family Foundation. Anthony Damico is an independent consultant to the Kaiser Family Foundation.